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Symptomatic Ossification of the Ligamentum Flavum: A Clinical Series From the French Antilles

Pascal-Moussellard, Hugues, MD*; Cabre, Philippe, MD; Smadja, Didier, PhD; Catonné, Yves, PhD*

doi: 10.1097/01.brs.0000169450.49181.91
Clinical Case Series
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Study Design. A series of 14 patients from the French Antilles treated for ossification of the ligamentum flavum (OLF).

Objectives. To describe the clinical and radiologic aspects, as well as disease course in a group of Caribbean patients. Also describe the use of sagittal computerized tomography (CT) reconstructions to distinguish OLF from calcification of the ligamenta flava.

Summary of Background Data. OLF is a rare disease described almost exclusively in Japanese patients. Only rarely are patients of African descent affected. No series of OLF in African American or African Caribbean subjects has previously been published.

Methods. A retrospective study of 14 consecutive patients, including 7 men and 7 women (mean age, 66.8 years), was conducted from 1996 to 2003. Diagnosis in each case was established using CT. Magnetic resonance imaging was also performed in every case. For the 11 patients treated surgically, pathology studies were performed.

Results. Walking difficulties were the most common presenting complaint. A picture of spastic paraparesis associated with sphincter dysfunction was the most common finding on initial examination. In each case, CT provided sufficient information to establish a diagnosis of OLF, while magnetic resonance imaging was helpful for showing spinal cord involvement. In most of the patients, OLF was located in the lower thoracic spine. Surgical decompression through a posterior approach resulted in regression of symptoms in all 11 patients treated surgically.

Conclusions. This study is the first reported series of OLF in a group of Caribbean patients. The disease appears to be underreported in the African Caribbean population. OLF can lead to debilitating thoracic myelopathy. Surgery is frequently indicated and achieves favorable results.

Ossification of the ligamentum flavum (OLF) is a rare disease described almost exclusively in Japanese patients. A retrospective study of 14 consecutive patients, including 7 men and 7 women (mean age, 66.8 years), was conducted from 1996 to 2003, involving African Caribbean patients. Diagnosis in each case was established using computerized tomography. Magnetic resonance imaging was also performed in every case. This study is the first reported series of OLF in a group of Caribbean patients. The disease appears to be underreported in the African Caribbean population. OLF can lead to debilitating thoracic myelopathy. Surgery is frequently indicated and can achieve favorable results.

From the Service *d’orthopédie Pr. Saillant, CHU Pitié-Salpétrière, Paris, and †de neurologie, CHRU La Meynard, Fort de France, Martinique, France.

Acknowledgment date: August 23, 2004. First revision date: November 20, 2004. Acceptance date: December 22, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Hugues Pascal-Moussellard, MD, Service d’orthopédie Pr Saillant, Pavillon Gaston Cordier, CHU Pitié-Salpétrière, Bd de l’Hôpital, 75013 Paris, France; E-mail: hpmous@sasi.fr

© 2005 Lippincott Williams & Wilkins, Inc.